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General NPI Number Information
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NPI Number | 1033619135
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Entity Type | Organization
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Legal Business Name | SPECTRUM HEALTH PRIMARY CARE PARTNERS
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 6201 68TH ST SE
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City | CALEDONIA
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State | MI
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Zip | 49316
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Country | US
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Telephone | 231-291-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE # MC845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE CHIEF MEDICAL OFFICER
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Name | DAVID OTTENBAKER
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Credential | MD
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Telephone | 616-486-6686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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